A Brief Overview:
Prozac (fluoxetine)
(floo-Ox-e-teen)
Ben Lehman, MSIII
Guide
What is Prozac?
What should I discuss with my healthcare provider prior to using Prozac?
How should I take Prozac?
What happens if I miss a dose?
What happens if I overdose?
Are there any contraindications to this medication?
Effects with other medications?
Possible side effects?
Where Can I get more information?
What is Prozac?
Prozac is an antidepressant in a group of drugs called selective serotonin reuptake inhibitors (SSRIs). Prozac affects chemicals in the brain that may become unbalanced and cause depression, panic, anxiety, or obsessive-compulsive symptoms.
Prozac is used to treat major depressive disorder, bulimia nervosa (an eating disorder) obsessive-compulsive disorder, panic disorder, and premenstrual dysphoric disorder (PMDD).
Prozac may also be used for purposes other than those listed in this medication guide.
What should I discuss with my healthcare provider prior to using Prozac?
Do not use Prozac if you are using any of the following drugs:
· pimozide (Orap);
· thioridazine (Mellaril); or
· an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), rasagiline (Azilect), or selegiline (Eldepryl, Emsam).
Serious and sometimes fatal reactions can occur when these medicines are taken with Prozac. You must wait at least 14 days after stopping an MAO inhibitor before you can take Prozac. You must wait 5 weeks after stopping Prozac before you can take thioridazine (Mellaril) or an MAOI.
Before taking Prozac, tell your doctor if you are allergic to any drugs, or if you have:
· diabetes;
· seizures or epilepsy;
· bipolar disorder (manic depression); or
· a history of drug abuse or suicidal thoughts.
If you have any of these conditions, you may not be able to use Prozac, or you may need a dosage adjustment or special tests.
You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old, or have Bipolar Disorder. Tell your doctor if you have worsening depression or suicidal thoughts during the first several weeks of treatment with Prozac, or whenever your dose is changed.
Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.
FDA pregnancy category C. SSRI antidepressants may cause serious or life-threatening lung problems in newborn babies whose mothers take the medication during pregnancy. However, you may have a relapse of depression if you stop taking your antidepressant during pregnancy. If you are planning a pregnancy, or if you become pregnant while taking Prozac, do not stop taking the medication without first talking to your doctor. Prozac can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.
Do not give Prozac to anyone younger than 18 years old without a doctor's advice. Prozac is FDA-approved for use in children with depression.
How should I take Prozac?
Take Prozac exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.
Your doctor may occasionally change your dose to make sure you get the best results from the medication.
Do not break, chew, or open an extended-release capsule. Swallow the pill whole. It is specially made to release medicine slowly in the body. Breaking the pill would cause too much of the drug to be released at one time.
Measure the liquid form of Prozac with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist where you can get one.
It may take 4 weeks or longer before you start feeling better. Do not stop using Prozac without first talking to your doctor. You may have unpleasant side effects if you stop taking this medication suddenly.
To treat premenstrual dysphoric disorder, the usual dose of Prozac is once daily while you are having your period, or 14 days before you expect your period to start. Follow your doctor's instructions.
Store Prozac at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember. However, if it is almost time for the next regularly scheduled dose, skip the missed dose and take the next one as directed. Do not take extra medicine to make up the missed dose.
If you miss a dose of Prozac Weekly, take the missed dose as soon as you remember and take the next dose 7 days later. However, if it is almost time for the next regularly scheduled weekly dose, skip the missed dose and take the next one as directed. Do not take extra medicine to make up the missed dose.
Seek emergency medical attention if you think you have taken too much of this medication. Overdose may cause nausea, vomiting, fever, sleepiness, rapid or uneven heartbeat, confusion, fainting, seizures, or coma.
Treatment should consist of those general measures employed in the management of overdosage with any drug effective in the treatment of Major Depressive Disorder.
Ensure an adequate airway, oxygenation, and ventilation. Monitor cardiac rhythm and vital signs. General supportive and symptomatic measures are also recommended. Induction of emesis is not recommended. Gastric lavage with a large-bore orogastric tube with appropriate airway protection, if needed, may be indicated if performed soon after ingestion, or in symptomatic patients.
Activated charcoal should be administered. Due to the large volume of distribution of this drug, forced diuresis, dialysis, hemoperfusion, and exchange transfusion are unlikely to be of benefit. No specific antidotes for fluoxetine are known.
A specific caution involves patients who are taking or have recently taken fluoxetine and might ingest excessive quantities of a TCA. In such a case, accumulation of the parent tricyclic and/or an active metabolite may increase the possibility of clinically significant sequelae and extend the time needed for close medical observation
Are there any contraindications to this medication?
When using Prozac and olanzapine in combination, also refer to the Contraindications section of the package insert for Symbyax (Prozac and Olanzapine combination)
The use of Prozac is contraindicated with the following:
-Monoamine Oxidase Inhibitors (in the last two weeks)
-Pimozide (Clinical studies of pimozide with other antidepressants demonstrate an increase in drug interaction or QTc prolongation)
-Thioridazine
Avoid drinking alcohol, which can increase some of the side effects of Prozac. This medicine can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.
There have been rare post-marketing reports of serotonin syndrome with use of an SSRI and a triptan. (migraine meds) If concomitant treatment of PROZAC with a triptan is clinically warranted, careful observation of the patient is advised, particularly during treatment initiation and dose increases.
Tell your doctor if you regularly use other medicines that make you sleepy (such as cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures or anxiety). They can add to sleepiness caused by Prozac.
Are there any effects when taken with other medications?
Talk to your doctor before taking any medicine for pain, arthritis, fever, or swelling. This includes aspirin and NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), diclofenac (Voltaren), indomethacin, piroxicam (Feldene), nabumetone (Relafen), etodolac (Lodine), and others. Taking any of these drugs with Prozac may cause you to bruise or bleed easily.
Before taking Prozac, tell your doctor if you are using any of the following medicines:
· alprazolam (Xanax);
· clozapine (Clozaril, Fazaclo);
· digitoxin (Crystodigin);
· flecainide (Tambocor);
· haloperidol (Haldol);
· seizure medication such as phenytoin (Dilantin) or carbamazepine (Tegretol);
· vinblastine (Velban);
· a blood thinner such as warfarin (Coumadin);
· almotriptan (Axert), frovatriptan (Frova), sumatriptan (Imitrex), naratriptan (Amerge), rizatriptan (Maxalt), or zolmitriptan (Zomig); or
· any other antidepressants such as amitriptyline (Elavil), escitalopram (Lexapro), imipramine (Tofranil), sertraline (Zoloft), and others.
This list is not complete and there may be other drugs that can interact with Prozac. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.
Possible side effects of Prozac (fluoxetine):
Get emergency medical help if you have any of these signs of an allergic reaction: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.
Call your doctor at once if you experience any of these serious side effects from using Prozac:
· severe blistering, peeling, and red skin rash;
· very stiff (rigid) muscles, high fever, sweating, fast or uneven heartbeats, tremors, overactive reflexes;
· nausea, vomiting, diarrhea, loss of appetite, feeling unsteady, loss of coordination; or
· headache, trouble concentrating, memory problems, weakness, confusion, hallucinations, fainting, seizure, shallow breathing or breathing that stops.
Less serious Prozac side effects may include:
· cold symptoms such as stuffy nose, sneezing, sore throat;
· drowsiness, dizziness, feeling nervous;
· mild nausea, upset stomach, constipation;
· increased appetite, weight changes;
· sleep problems (insomnia);
· decreased sex drive, impotence, or difficulty having an orgasm; or
· dry mouth.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Where Can I get more information?
Your pharmacist has additional information about Prozac (fluoxetine) written for health professionals that you may read.
Remember, keep this and all other medications out of reach of children, never share medicines with others, and use this medication only for the indication prescribed.
(information obtained from Eli Lilly & Co., drugs.com, and Rxlist)
